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Mgr/Si,33 <br />ki <br />APPLICATION FOR RIGHT-OF-WAY USE PERMIT <br />Type or print clearly with Ink <br />PRESS HARD - YOU ARE MAKING COPIES <br />PUBLIC WORKS <br />EVERETT, WASHINGTON PERMIT NO. <br />APPLICANT (UNDERSIGNED) AND FIRM REPRESENTED, IF ANY:%7 "rt'ND TJ \ ----v-- `- <br />HEREBY APPLIES FOR PERMISSION TOb e <br />AT THE FOLLOW114G LOCATION <br />DRAWING (WORK TO BE DONE) OR THREE PLANS ATTACHED: <br />PERMIT IS VALID FOR 60 DAYS <br />COPY OF THIS APPLICATION TO BE POSTED <br />ON JOBSITE. <br />CALL FOR INSPECTION P-59-881 1 <br />24 HOURS BEFORE CONSTRUCTION <br />SEWER <br />DRAINAGE <br />WATER <br />STREET <br />DEPARTMENT APPROVALS <br />COMMUNICATIONS <br />TRAFFIC <br />PLANNING <br />&1 � �77- 3 -.2 -c/ <br />APPROVED FO CONS RUCTION DATE <br />APPROVED AS CONSTRUCTS D>TE <br />T1'1 1 11 CONSTRUCTION/AS BUILT <br />JQ9(] 2mo* D710'; - <br />e wA <br />n <br />Y1 Lo'U G C � \C 5 1-j VT <br />DRIVEWAY SECTION <br />I" LIP --� <br />30'y 30" <br />The undersigned owner hereby agrees to hold and save harmless <br />the City of Everett from any and all claims for damages, costs. <br />expensesor causes of action that may arise because of installahon <br />and maintenance of the Improvement or other rlghl-of-way use <br />hereto applied for and further agrees to remove same upon notice <br />from the City and to replace public property damaged thereby. <br />NATURE OF APPLICANT <br />ADDRESS <br />yt p �i i.7 1i.7 C id 9'�0 y <br />CITv ZIP <br />-.JOG <br />TELEPHONE NUMBER ALTERNATE <br />,-;[ D 8l <br />DATE <br />FEE 1978 <br />